Pulp Canal Obliteration Following Traumatic Dental Injury in an Upper Lateral Incisor: A Case Report with 3-year Follow-up.

Endodontic management of teeth afflicted with pulp canal obliteration faces a challenge due to the heightened risk of complications including excessive wear, perforation, and suboptimal chemomechanical preparation. This report aims to elucidate the clinical endodontic strategy employed in addressing pulp canal obliteration after a history of dental trauma and an associated periradicular lesion in an upper lateral incisor. A patient visited the dental emergency department with symptoms of apical swelling, acute persistent pain, and discoloration of tooth 22. Following comprehensive clinical evaluation and cone-beam computed tomography, the diagnosis of pulp canal obliteration involving the cervical and middle thirds of the tooth, alongside an acute periradicular abscess was established. Root canal was accessed using tomographic image planning, augmented by loupe magnification and ultrasonic instrumentation. Precise identification of the access cavity was radiographically confirmed, preceded by thorough irrigation with 2.5% sodium hypochlorite and subsequent cervical and middle third preparation. Verification of the working length by an electronic apex locator ensured precise apical preparation, followed by passive ultrasonic irrigation to optimize disinfection and to enhance penetrability of intracanal calcium hydroxide medication, administered for 15 days to eliminate microbial invasion. Upon resolution of symptoms, root canal obturation employing thermo-mechanical compaction and coronal sealing with composite resin was accomplished. Radiographic assessment after a one-year interval presented evidence of lesion regression and bone repair. Subsequent cone-beam computed tomography imaging at the three-year follow-up confirmed complete healing of the periradicular tissues, attesting to the efficacy of the endodontic intervention.

Clinicopathological characteristics of odontogenic carcinosarcoma: A systematic review.

BACKGROUND: The aim of the present systematic review was to summarize evidence on odontogenic carcinosarcoma, analyzing clinical, epidemiological, imaging, histopathological, immunohistochemical, therapeutic, and prognostic features of this tumor. MATERIALS AND METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in the Ovid MEDLINE (Wolters Kluwer), PubMed (National Library of Medicine), Web of Science (Thomson Reuters), Scopus (Elsevier), and LILACS (Latin American and Caribbean Center on Health Sciences Information) databases, without publication date or language restrictions. Case reports or case series of OCS reporting clinical, radiological, and histopathological data that confirmed the diagnosis were selected. The Joanna Briggs Institute-University of Adelaide tool was used for critical appraisal of the included articles. RESULTS: Odontogenic carcinosarcoma is a rare, aggressive tumor associated with high mortality; however, the metastasis rate is low. The tumor has a male predilection. The mean patient age is 40 years, but there is no predilection for age. The left posterior mandible is the most affected site, but no specific radiographic features have been reported. CONCLUSION: Given its rarity, dentists, oral-maxillofacial surgeons, and physicians need to be aware of odontogenic carcinosarcoma in order to increase the diagnostic potential, preventing delays in diagnosis and treatment and thus contributing to lower morbidity of the tumor.

Endodontic and Surgical Management of an Invasive Cervical Resorption in a Maxillary Central Incisor: A Case Report.

The current study aims to report a case of invasive cervical resorption in a maxillary left central incisor with a history of dental trauma. After thorough clinical and tomographic evaluations, cervical cavitation, an irregularity in the gingival contour and crown discoloration were observed. Furthermore, presence of an extensive and well-defined area of invasive cervical resorption with pulp communication was discovered. The suggested diagnosis was asymptomatic irreversible pulpitis. The resorption area was treated with the complete removal of granulation tissue, sealed with light-curing glass ionomer cement. Then, the chemo-mechanical preparation and obturation of the root canal were performed. After two years of clinical follow-up and cone-beam computed tomography examination, there were no clinical signs and symptoms, the filling of the resorption area remained intact, and no hypodense image in the cervical region of tooth #21 could be detected. The management reported in this case presented a possible viable treatment for invasive cervical resorption, provided that correct diagnosis is made.

Cyclic Fatigue Resistance of Blue Heat-Treated Instruments at Different Temperatures.

The main aim is to evaluate the cyclic fatigue resistance of blue heat-treated instruments with different kinematics. Twenty-four endodontic instruments of the same brand were used for each of three experimental groups: VB (Vortex Blue 40/0.04), RB (RECIPROC Blue 40/0.06), and XB (X1 Blue 40/0.06). The instruments were randomly distributed and subjected to temperatures of 20°C and 37°C. The fatigue test was performed using a stainless steel device. Data were analysed using the Shapiro-Wilk test, Student's t-test, the F test, and Tukey's and Tamhane tests at significance level P=0.05. The instruments' cyclic fatigue resistance at both temperatures differed significantly for each instrument type (P < 0.001). The RB instruments displayed greater cyclic fatigue resistance at the tested temperatures compared with the VB and XB instruments (P < 0.001). Reciprocating kinematics positively influenced cyclic fatigue resistance. Blue heat-treated instruments showed decreased cyclic fatigue resistance as the temperature increased (P < 0.001).

Influence of occlusal reduction on pain after endodontic treatment: a systematic review and meta-analysis.

The purpose of this systematic review was to analyze the influence of occlusal reduction on the postoperative pain levels after endodontic treatment (instrumentation and obturation of the root canal system). This review followed the PRISMA statement and was registered at PROSPERO (CRD42018107918). Two independent reviewers searched the Lilacs, Cochrane Library, PubMed (Medline), Web of Science, Scopus, Scielo, and ScienceDirect for articles published until April 2021. The research question was, "Does occlusal reduction decrease postoperative pain in endodontically treated teeth?". Only randomized clinical trials were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (presence or absence of pain). The search strategies retrieved 4114 studies. Twelve studies were included for qualitative analysis and nine for quantitative analysis. The meta-analysis results did not reveal a significant difference in the reduction of postoperative pain levels for endodontic instrumentation at 6, 12, 24, 48 h and for endodontic obturation at 6 or 12 h after occlusal reduction. According to the GRADE tool, the analyzed outcome was classified as having a moderate level of certainty. It is concluded that occlusal reduction does not interfere with postoperative pain levels after endodontic treatment.

Tooth autotransplantation using an interdisciplinary approach to rehabilitation in a young patient: Case report with 7-year follow-up.

This case report demonstrates the possibility of functional and aesthetic rehabilitation using an interdisciplinary approach in a child following avulsion of a tooth. Autotransplantation after the development of calcific metamorphosis of the pulp and acute apical periodontitis provided satisfactory repair after root canal treatment. A 7-year-old white boy avulsed the right maxillary central incisor (tooth 11). The extra-alveolar time exceeded 60 minutes, and this triggered external replacement resorption of the avulsed tooth. At 11 years of age, the child underwent tooth autotransplantation. After 4 years of follow-up, intraoral clinical and radiographic examination led to the diagnosis of calcific metamorphosis of the pulp and acute apical periodontitis. The patient had minimally invasive root canal treatment, orthodontic treatment and esthetic rehabilitation with a porcelain crown. Control periapical radiography and tomography of the autotransplanted tooth after 7 years revealed bone repair in the periapical region. This case report indicates that tooth autotransplantation can be used to replace anterior teeth after avulsion followed by replacement resorption. Interdisciplinary management helped to maintain the esthetics and function of the rehabilitated area.

Photobiomodulation Therapy in the Proliferation and Differentiation of Human Umbilical Cord Mesenchymal Stem Cells: An In Vitro Study.

Introduction: Since photobiomodulation therapy (PBMT) favors in vitro mesenchymal stem cell (MSC) preconditioning before MSC transplantation, increasing the proliferation of these cells without molecular injuries by conserving their characteristics, in the present in vitro study we analyzed the effect of PBMT on the proliferation and osteogenic differentiation of human umbilical cord mesenchymal stem cells (hUCMSCs). Methods: Irradiation with an InGaAIP Laser (660 nm, 10 mW, 2.5 J/cm2 , 0.08 cm2 spot size, and 10 s) was carried out. The cells were divided into four groups: CONTROL [cells grown in Dulbecco's Modified Eagle Medium (DMEM)], OSTEO (cells grown in an osteogenic medium); PBMT (cells grown in DMEM+PBMT), and OSTEO+PBMT (cells grown in an osteogenic medium plus PBMT). The cell proliferation curve was obtained over periods of 24, 48 and 72 hours using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Osteogenic differentiation was analyzed by the formation of calcium nodules over periods of 7, 14 and 21 days. Morphometric analysis was performed to quantify the total area of nodular calcification. Results: The highest cell proliferation and cell differentiation occurred in the OSTEO+PBMT group, followed by the PBMT, OSTEO and CONTROL groups respectively, at the observed times (P <0.05). Conclusion: PBMT enhanced the osteogenic proliferation and the differentiation of hUCMSCs during the periods tested, without causing damage to the cells and preserving their specific characteristics, a fact that may represent an innovative pretreatment in the application of stem cells.

Influence of Temperature on the Cyclic Fatigue of Nickel-Titanium Instruments with Different Heat Treatments on Severely Curved Canals.

AIM: This study aims to investigate the influence of temperatures of 20 °C and 37 °C on the resistance to cyclic fatigue of NiTi instruments with different heat treatments, as tested in severely curved simulated canals. MATERIALS AND METHODS: Seventy-two instruments were distributed according to the temperature used (20 °C and 37 °C): XP-endo Shaper (30/0.01), ProDesign Logic (30/0.05), and iRaCe (30/0.04). The instruments were rotated freely until the occurrence of fracture inside an artificial severely curved stainless steel canal, which had a 90° angle of curvature and a curvature radius of 5 mm. Kolmogorov-Smirnov, Wilcoxon, ANOVA, and Kruskal-Wallis tests were performed. A p value of <0.05 was considered statistically significant. RESULTS: XP-endo Shaper instruments presented higher NCF values and time to failure compared with ProDesign Logic and iRaCe instruments at 20 °C and 37 °C (p < 0.001). CONCLUSION: Within the limitations of this study, the results show that the body temperature (37 °C) significantly lowers the resistance to cyclic fatigue of all instruments compared with 20 °C. CLINICAL SIGNIFICANCE: Body temperature is an important factor in the results of cyclic fatigue tests.

Analysis of Aloe vera cytotoxicity and genotoxicity associated with endodontic medication and laser photobiomodulation.

This study aims to evaluate, in vitro, the effect of Aloe vera associated with endodontic medication, with or without laser photobiomodulation (FTL) irradiation in FP6 human pulp fibroblasts. The materials were divided into eight groups: CTR - control; CL - FTL alone; AA - Aloe vera with distilled water; AL - Aloe vera with distilled water and FTL; HA - calcium hydroxide P.A. with distilled water; HL - calcium hydroxide P.A. with distilled water and FTL; HAA - calcium hydroxide P.A. with Aloe vera and distilled water; HAL - calcium hydroxide P.A. with Aloe vera, distilled water, and FTL. The cytotoxicity was evaluated by MTT assay at 24, 48, and 72h and the genotoxicity by micronucleus test assay. This study was performed in triplicate. Data obtained in both tests were statistically analyzed by ANOVA and Tukey's tests (p≤0.05). Group AA presented high genotoxicity and low cytotoxicity. After 24, 48, and 72h, the group HAA significantly reduced the cell viability. Interaction with FTL showed slightly increase cell viability after 24 and 48h in groups CL and HL (p<0.001), despite the high genotoxicity in group CL and low genotoxicity in group HL. Group AL showed higher cell survival rate at 72h (p<0.05) and high genotoxicity (p<0.001). It was concluded that Aloe vera allowed higher cell viability in human pulp fibroblasts in the presence of calcium hydroxide or with FTL separately, but genotoxicity increased in these associations.

The Promising Applications of Stem Cells in the Oral Region: Literature Review.

INTRODUCTION: For a long time researchers have tried to find out a way to grow tissues back to the human body in order to solve transplantation problems by offering the unique opportunity to have their organs back, working properly, in search of life dignity. LITERATURE REVIEW: Stem cells seem to be present in many other tissues than researchers had once thought; and in some specific sites they can be easily collected, without the need of expensive interventions. The oral cavity is one of these regions where their collection can be accomplished, with plenty of accessible sites enriched with these precious cells. AIM: The aim of this literature review is to research where in the mouth can scientists find stem cells to be used in the near future. KEY-MESSAGE: The aim of this literature review is to research where stem cells can be found and collected in the oral cavity.

Detection of vertical root fractures in endodontically treated teeth in the absence and in the presence of metal post by cone-beam computed tomography.

BACKGROUND: Aim of this study was to investigate the influence of gutta-percha and metallic posts on the efficiency of Cone Beam Computed Tomography (CBCT) in diagnosing Vertical Root Fracture (VRF). METHODS: Forty-eight teeth were divided into 3 experimental and 3 control groups. The teeth of the first experimental group and the first control group received neither gutta-percha nor metal posts. The teeth of the second experimental group and the second control group were filled with gutta-percha, and the teeth of the third experimental group and the third control group were filled with the metal posts. The teeth of the experimental groups were artificially fractured. The teeth were evaluated through images taken by a Prexion scanner with a 0.1 mm resolution. Fisher's exact test was used to measure the following values: sensitivity, false negative, specificity, false positive and accuracy for the VRF detection through the scanner. Three observers calibrated and blinded to the protocol evaluated the images. RESULTS: The inter-observer Kappa coefficient was 0.83. The presence of posts and gutta-percha reduced the sensitivity and the accuracy in detecting the VRF. Regarding to the sensitivity (p = 0.837, p = 0.304, p = 0.837 for evaluator 1, 2 and 3, respectively) and specificity (p = 0.162, p = 0.056, p = 0.062 for evaluator 1, 2 and 3, respectively), Fisher's exact test showed no statistically significant difference among the evaluated groups. However, a significant difference was observed in relation to the accuracy in the results of evaluator 2 (p = 0.03), which showed a much lower accuracy for the post group (50 %) than for the Nonfilled group (93.8 %). CONCLUSIONS: The Prexion tomograph was precise in detecting vertical root fractures and the CBCT diagnostic ability was not influenced by the presence of posts or gutta-percha.

IS GUTTACORE MORE EASILY REMOVED FROM THE ROOT CANAL THAN THERMAFIL? AN EX-VIVO STUDY.

GuttaCore is a new cross-linked gutta-percha carrier. Its handling time and ease of removal were compared with those of a plastic carrier (Thermafil) and the continuous wave of condensation technique (control). Forty-five maxillary central incisors were randomly divided 3 groups according to filling technique and retreatment was carried out in all samples with NiTi rotary files, hand files and ultrasonic inserts. Time required for filling removal was recorded. Roots were then split longitudinally and photographed under 5x magnification, and residual filling material was quantified. Removal time was significantly longer for Thermafil (7.10 minutes) than GuttaCore (2.91 minutes) and the control group (1.93 minutes) (p < 0.001). The amount of residual filling material did not differ among the groups: Thermafil 8.31%, GuttaCore 6.27 and control 8.68% (p > 0.05). In conclusion, replacing plastic core with cross-linked gutta-percha allows easier removal of carrier from the root canal. The remnants of filling material in all samples illustrate that retreatment remains a challenge in endodontics.

Filling lateral canals: influence of calcium hydroxide paste as a root canal dressing.

CONTEXT: The use of intracanal medication aims to provide antimicrobial activity in the root canal system, leading to a more satisfactory condition for root canal obturation. However, it is important to evaluate whether such medication would affect the sealing-off from the main root canal of ramifications such as lateral canals. AIM: Evaluate the influence of calcium hydroxide [Ca(OH)2] paste on the filling of lateral canals. SETTINGS AND DESIGN: Ex vivo quantitative laboratory study. MATERIALS AND METHODS: Sixty single-rooted teeth with lateral canals created were used, 10 teeth per group. Group A was described respectively as lateral condensation technique (subgroup 1), thermomechanical compaction (subgroup 2), and continuous wave of condensation (subgroup 3). In Group B, subgroups 4, 5, and 6 were filled with Ca(OH)2 for 7 days before filling using the techniques applied in subgroups 1, 2, and 3. Radiographic evaluation was performed to count the number of filled lateral canals in each group. The teeth were cross-sectioned over the lateral canals; thus, 180 specimens were obtained. Each specimen was immersed in a polyester resin. Digital images were obtained and specific software (Image Tool; ) was used to evaluate the number of obturated lateral canals and the filling length in each lateral canal of groups. STATISTICAL ANALYSIS USED: Data were statistically analyzed using SPSS 12.0 for Windows (Descriptive statistical analysis and Newman-Keuls test). RESULTS: A greater number of simulated lateral canals were filled in Group A (91.1%). Group B had less filled lateral canals (33.3%). The sealing of lateral canals was statistically different between Group B (26.15%) and Group A (74.43%). CONCLUSIONS: According to the radiographic analysis and the linear filling measurement, the use of Ca(OH)2 decreased the number and the length of sealed lateral canals.

Short-term analysis of human dental pulps after direct capping with portland cement.

This study evaluated the short-term response of human pulp tissue when directly capped with Portland cement. In this series of cases, twenty human third molars that were scheduled for extraction were used. After cavity preparation, pulp exposure was achieved and Portland cement pulp capping was performed. Teeth were extracted after 1, 7, 14 and 21 days following treatment and prepared for histological examination and bacterial detection. Each group had 5 teeth. The results were descriptively analysed. Dentin bridge formation was seen in two teeth with some distance from the material interface (14 and 21 days). Soft inflammatory responses were observed in most of the cases. Bacteria were not disclosed in any specimen. PC exhibited some features of biocompatibility and capability of inducing mineral pulp response in short-term evaluation. The results suggested that PC has a potential to be used as a less expensive pulp capping material in comparison to other pulp capping materials.

The accuracy of root canal measurements using the Mini Apex Locator and Root ZX-II: an evaluation in vitro.

OBJECTIVE: The aim of this in vitro study was to compare the capacity of the Root ZX-II and Mini Apex Locator, electronic apex locators (EALS), to prevent overestimated working length. STUDY DESIGN: Forty extracted human teeth were used for the study. The cervical portion of each canal was flared using Gates Glidden drills and the teeth were embedded in an alginate model. Canals were irrigated with 2.5% sodium hypochlorite. The actual length (AL) and electronic length (EL) measurements were made on each specimen separately with both devices with the aid of a k-type file. RESULTS: The results obtained with each EAL were compared with the corresponding actual length. The statistical analysis of the results showed EAL reliability to prevent overestimated working length to be 100% for the Mini Apex Locator and 97.44% for the Root ZX-II, within a tolerance of +/-0.5 mm into account. A paired sample t test showed that there was no statistically significant difference between the accuracy of the devices (P = .5841). CONCLUSION: The results of this study indicate that the Root ZX-II and Mini Apex Locator are accurate devices to prevent overestimated working length.

In vitro comparative study of manual and mechanical rotary instrumentation of root canals using computed tomography.

This in vitro study compared, using computed tomography (CT), the amount of dentin removed from root canal walls by manual and mechanical rotary instrumentation techniques. Forty mandibular incisors with dental crown and a single canal were selected. The teeth were randomly assigned to two groups, according to the technique used for root canal preparation: Group I - manual instrumentation with stainless steel files; Group II - mechanical instrumentation with RaCe rotary nickel-titanium instruments. In each tooth, root dentin thickness of the buccal, lingual, mesial and distal surfaces in the apical, middle and cervical thirds of the canal was measured (in mm) using a multislice CT scanner (Siemens Emotion, Duo). Data were stored in the SPSS v. 11.5 and SigmaPlot 2001 v. 7.101 softwares. After crown opening, working length was determined, root canals were instrumented and new CT scans were taken for assessment of root dentin thickness. Pre- and post-instrumentation data were compared and analyzed statistically by ANOVA and Tukey's post-hoc test for significant differences (p=0.05). Based on the findings of this study, it may be concluded that regarding dentin removal from root canal walls during instrumentation, neither of the techniques can be considered more effective than the other.

Histologic evaluation of pulpotomy performed with ethyl-cyanoacrylate and calcium hydroxide.

The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3% of Group 1, and in 100% of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50% of the ethyl-cyanoacrylate group and 75% of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.

The ability of two apex locators to locate the apical foramen: an in vitro study.

The objective of this study was to compare the accuracy of the Root-ZX and Novapex electronic apex locators (EALs) in locating the apical foramen. Forty extracted human teeth were used. The coronal portion of each canal was flared using Gates Glidden drill. Canals were irrigated with 2.5% sodium hypochlorite. The actual length (AL) and electronic length (EL) measurements were made on each specimen separately with both devices with an aid of a K-type file. The results obtained with each EAL were compared with the corresponding control length. The statistical analysis of the results showed EAL reliability in detecting the apical foramen to 89.7% for the Root-ZX and 82.1% for the Novapex, taking the tolerance of +/-0.5 mm into account. A paired sample t test showed that there was no statistically significant difference between the accuracy of the devices (p = 0.4305). The results of this study indicate that the Root-ZX and Novapex are useful and accurate devices for the apical foramen location.

Cohort study of endodontic therapy success.

A retrospective cohort study was carried out aiming to assess the success rate of endodontic treatment of patients from the Faculty of Dentistry, University of Pernambuco, Brazil. The dental records of the sampling comprised all patients treated in 1998 and 1999. Trials were standardized and a pilot study was carried out to determine the feasibility of the proposed study. Chi-square and Fisher's exact tests were used to calculate the level of significance that was set at 5%. Logistic regression models were used to confirm significant effect of some variables on the endodontic outcome. The final sample size comprised 311 (75.9%) women and 99 (21.1%) men. The majority of cases (82.9%) were considered successful. Success was less frequent for patients with up to primary school education (55.6%) than for those with a higher degree of education (89.7%). The vital condition of the pulp showed a statistically significant relationship with the success of endodontic therapy (p < 0.05). These results suggest that it is possible to attain very high success rates for endodontic treatment when both the intraradicular andthe extraradicular causes of failure of endodontic treatment are well managed.